Evaluación inmunológica de líquidos cefalorraquídeos de pacientes con esclerosis múltiple, en búsqueda de nuevas herramientas diagnósticas. ICGES 2005 - 2006

La Esclerosis Múltiple (EM) es una enfermedad inflamatoria, caracterizada por la desmielinización de la sustancia blanca. Su diagnóstico está basado en parámetros clínicos y paraclínicos. No existe una prueba diagnóstica definitiva para esta enfermedad. En este estudio, cuantificamos por nefelometría la forma libre de las cadenas ligeras kappa (CLklibre) de las inmunoglobulinas y medimos la concentración de varias citocinas en el LCR por el método de ELISA. De esta manera evaluamos la inmunidad humoral y celular intratecal de los pacientes del estudio, con el fin de encontrar nuevas herramientas que contribuyan al diagnóstico de esta enfermedad. Se analizaron 63 muestras pares de LCR y sueros a los cuales se les determinó los cocientes de albúmina y el índice de Link, parámetros que brindan información sobre el estado de la barrera hematoencéfalica (BI-JE) y la síntesis intratecal de inmunoglobulinas. Luego de conocer el estado intratecal en estos pacientes, se midió la concentración de CLk libre en el LCR. Además, trabajamos con 68 LCRs a los cuales se evaluaron las concentraciones de IL-JO, TNFz y lNF7 y sIL-2R. Los resultados obtenidos al evaluar la presencia de CLk libre de las inmunoglobulinas, fueron comparados con el método de referencia (Bandas Oligoclonales/Isoelectroenfoque), encontrando que la técnica de CLk libres de las inmunoglobulinas por nefelometría presenta una sensibilidad del 94% y una especificidad de 83%. Los resultados obtenidos en cuanto el estado intratecal de nuestras muestras tenemos que: en el grupo 1 (pacientes que no padecen EM por los métodos de laboratorio) el 24% presenta daño de la BHE y síntesis intratecal, y el 20% presentan valores detectables de CLk libre. Mientras que para el grupo 11 (paciente con síntesis intratecal de Ig detectada por RO, con posible EM) presentan un 67% de síntesis intratecal y un 92% presencia de CLklibre, El estado de la BHE varía dependiendo que patrón de RO presente. En cuanto a las citocinas medidas, a excepción del sIL-2R, no mostraron valores detectables por esta metodología. En base a nuestros resultados, concluimos que, la técnica de nefelometría para detectar las CLk libres de las inmunoglobulinas es una metodología sensible, rápida y de bajo costo que puede contribuir con el diagnóstico de la EM, y que nos ofrece una evaluación de la respuesta inmune humoral, mientras que el slL-2R contribuye a evaluar el estado inmune celular del espacio intratecal de estos pacientes

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Evidencia serológica de infecciones de Rickettsia en humanos provenientes de tres localidades de Panamá

Introduction: Since the middle of last century, cases of rickettsiosis have been found in Panamá when outbreaks of murine typhus and spotted fever were reported. Since then, little information exists about its prevalence in this country, since it is most often is misdiagnosed as another disease.Objectives: The aim of this paper is to demonstrate the presence of Rickettsia infections in humans in three locations in Panamá. These locations are agricultural areas, near forested areas or those whowork in zoo.Materials and methods: Three locations where chosen for this study: Tortí, El Valle de Antón and workers in the Summit Municipal Park in Panamá City. All volunteers signed an informed consent and answered a questionnaire. The samples were analyzed for the detection of rickettsial spotted fever and typhus group by the indirect immunofluorescence (using commercial kits) and antigens of Rickettsia rickettsii and R. amblyommii.Results: Blood samples were taken from 97 volunteers in Tortí (25), El Valle de Anton (37) and Summit Municipal Park (35). Of these, a total of 38 (39%) samples reacted to one of the two methods: eight (32%) in Tortí, 18 (48%) in El valle and 12 (34%) in Summit Municipal Park.Conclusion: The results show a high prevalence of antibodies to Rickettsia belonging to the spotted fever group in each of the three study areas, in addition to presenting evidence of the typhus group Rickettsia in El Valle de Anton. These areas could be considered endemic for rickettsiosis as there are conditions for maintaining them. doi: http://dx.doi.org/10.7705/biomedica.v33i0.831 Introducción. Desde mediados del siglo pasado, se conocen en Panamá casos de rickettsiosis, cuando fueron reportados brotes de tifus en ratones y de fiebres manchadas. A partir de entonces, poca información se tiene sobre su prevalencia en este país, lo cual se debe principalmente a que son confundidos con otras enfermedades.Objetivos. El objetivo de este trabajo fue demostrar la presencia de rickettsiosis en humanos provenientes de tres localidades de Panamá, que corresponden a zonas agropecuarias, cercanas a bosques, o que trabajaban en zoológicos.Materiales y métodos. Se escogieron tres localidades para este estudio: Tortí (provincia de Panamá), El Valle de Antón (provincia de Coclé) y el Parque Municipal Summit en Ciudad de Panamá. Los voluntarios firmaron un consentimiento informado, además de responder un cuestionario. De cada voluntario se extrajo sangre venosa, la que fue analizada por medio de inmunoflorescencia indirecta, utilizando kits comerciales y láminas sensibilizadas con antígenos cultivados de Rickettsia rickettsii y Rickettsia amblyommii.Resultados. Se tomaron muestras de 97 voluntarios, 25 en Tortí, 37 en El Valle de Antón y 35 en el Parque Municipal Summit. De estos, 38 (39 %) de las muestras fueron positivas en algunas de las dos técnicas practicadas: 8 (32 %) en Tortí, 18 (48 %) en El Valle y 12 (34 %) en el Parque Municipal Summit.Conclusión. Se demuestra una alta prevalencia de anticuerpos contra Rickettsia del grupo de las fiebres manchadas en las tres áreas de estudio, además de presentarse evidencia de títulos para Rickettsia del grupo tifus en El Valle de Antón. Estas zonas podrían considerarse como endémicas por rickettsiosis, ya que existen condiciones que permiten el mantenimiento de las mismas.doi: http://dx.doi.org/10.7705/biomedica.v33i0.831

Correlates of Sexually Transmitted Infections among Adolescents Attending Public High Schools, Panama, 2015.

BACKGROUND:Sexually transmitted infections (STIs) are common in adolescents worldwide. Vulnerability to STIs increases with risky sexual practices. This study described the sexual practices, estimated the prevalence of STIs, and identified correlates associated with STIs among participants, enrolled in public high schools, in the District of Panama, Panama. METHODS:A cross sectional study, using multistage cluster sampling, was conducted among participants, aged 14-18 years, enrolled in public high schools, in the District of Panama, Panama City, Panama, from August to November, 2015. Participants completed a self-administered questionnaire and provided biological samples. The samples of those reporting sexual activity (oral, vaginal, and/or anal intercourse) were tested for STIs. Odds ratios were used to identify correlates of STIs in this population. RESULTS:A total of 592 participants were included, of whom, 60.8% reported a history of sexual activity, and 24.4% tested positive for least one STI. STIs were more common in female participants, (33.5%). Compared to those without STIs, higher proportions of those with at least one STI reported ≥3 sexual partners in their lifetime (60.0%) and current sexual activity (76.3%). In the multivariable model, correlates of STI included female participants (Adjusted Odds Ratio (AOR) = 5.8, 95% Confidence Interval (CI) 2.3-14.6) and those who engaged in sexual intercourse with casual partners (AOR = 3.0, 95% CI: 1.2-7.5). CONCLUSIONS:We report a high STI prevalence among adolescents attending public high schools, in the District of Panama. Reported risky sexual practices were common and correlated with STIs. Female participants and those reporting sexual intercourse with casual partners were more likely test positive for at least one STI. Our study identified a need for effective interventions to curb future infections in this population

Prevalence of Sexually Transmitted Infections Among Participants with a History of Sexual Activity, by Sex, Panama, 2015.

<p>Prevalence of Sexually Transmitted Infections Among Participants with a History of Sexual Activity, by Sex, Panama, 2015.</p

Correlates of STIs Among Participants (14–18 years old), Panama, 2015.

<p>Correlates of STIs Among Participants (14–18 years old), Panama, 2015.</p

Reported Sexual Practices Among Participants with a History of Sexual Activity, Panama, 2015.

<p>Reported Sexual Practices Among Participants with a History of Sexual Activity, Panama, 2015.</p

Reported Characteristics of Participants, by History of Sexual Activity, Panama, 2015.

<p>Reported Characteristics of Participants, by History of Sexual Activity, Panama, 2015.</p